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Frequently Asked Questions 2006

Frequently Ask-The-Doctor Questions Asked

Archives 2009 2008 2007  2006  2005


Posted December 29, 2006

Q My daughter has been practicing track for the last 4 months but now she can't run a full stride because her right leg feels weak when she runs it's like she can't bring it all the way up a full extension she did not do anything to injure it I don't know what to do she wants to run so bad but her right leg at the top in the front feels weak.

A Weakness in a large and strong muscle group needs an evaluation by a neurologist to ensure that a nerve injury has not occurred.  Once this has been ruled out and the nerves are healthy and working then return to the previous advice on structural malalignments that therapists and chiropractors may be able to correct.  When you find the cause of her weakness, would you send me her diagnosis? 


Posted December 29, 2006

Q My son is a 16 yr. old soph. who is a pitcher.  He plays Premier baseball out of STL.  Was clocked last summer at Purdue throwing 86 at age 15.  On November 2nd, a kid attempted to kick him and he blocked it with his right hand.  The X-ray was negative so he finished football (Varsity QB), went on to basketball, and started his 12 week baseball school in STL.  He still c/o some tenderness when shooting or batting, but not throwing.  We had a 2nd x-ray 3 weeks ago-it too was neg. Yesterday, he had an MRI that showed a scaphoid fracture.  Our wrist/hand surgeon recommends pinning it (I guess it is really a permanent screw).  Honestly, he continues to have good ROM for the most part.  He does wear a wrist brace during competition, etc. Obviously after yesterday, he is done with basketball and surgery is scheduled for next Wednesday.

My question is, do you feel he will lose any mobility in that wrist that may affect his pitching?  I am a nervous wreck as several universities have shown interest in him.  And he still has 3 HS and 3 Premier season remaining.

A The scaphoid bone has a blood supply and when it fractures, the clinical decision is based on the potential of loosing the blood supply to the bone.  When you lose the blood supply, the distal bone will die off "avascular necrosis" of the scaphoid.  Surgery is based on clinical opinion.  If you have doubts, get a second opinion.  Now the second question, surgery is completed and is "successful" in what it was to accomplish, that being pinning the fractured halves together.   However, in some cases the trauma of surgery causes microscars and limit full range of motion.  I've had several college players, a pole vaulter and a basketball player have fractures of the wrist bones, surgery and loss of greater than 50% range of motion in spite of very aggressive physical therapy and hand therapy specialists.  I used my technique that I
describe in my clinical articles and within 15 minutes was able to manipulate and reposition the wrist bones in alignment gaining full range of motion.  If your son loses range of motion, consider bringing him down for an hour session and I will do my best to correct his biomechanical alignments of the small wrist bones. 


Posted December 29, 2006

Q I truly admire the manner in which your site has expressed the Muscle Memory Phenomena.  In youth sports, ages 14-18, we are in some ways trying to get the baseball players to lose some muscle memory since they have picked up bad habits, and now it is extremely difficult to change. As you can imagine, in baseball, every little league volunteer dad who is a coach believes they are teaching correct fundamentals, but in many cases it is a false fundamental that they learned form their coach in little league who was probably also a volunteer father.
 
 I am thinking it might be prudent to let the players have 4-5 weeks off other than core building and light drills, in a hope to re-program their muscles.  Have you had any experience with deprogramming so we can begin to teach them correctly?

A I must say that you raise a great question.  De-programming previously learned biomechanics in order to establish new patterns.  I haven't run across any literature concerning this phenomenon.  Intuitively thinking I would propose the following:  Start with proper set up in feet and balance.  Establish a center of balance and rotation and work in sequence of the mechanics of pitching or batting in larger muscle groups more proximally, then sequentially work your instruction to the smaller muscle of the wrist, hand and fingers.  This way one starts with a base and adds the finer movements later.  Although this is conceptual, I think over the 5-6 weeks, you can re-establish a new blueprint of movement.  Please write back on your experiences and thoughts as I would like more input from the teachers themselves. 


Posted December 29, 2006

Q I was reading the article about joint mobs for the wrist. I have a patient who fell on an outstretched hand and resulted in a radial metaphysis fracture. She was casted for 8 weeks in wrist flexion and pronation and now she is very tight. What joint mobilization techniques would i use to increase forearm supination, and what grade would it be? what position would the patient be in? 

A My best reply is to try to read through my article and experiment yourself.  It would not be possible to explain without examining and working with your patient and describing positions as each wrist has its own complex presentations.  I will email an answer that I responded to earlier today.  Sorry I wasn't that helpful for you.


Posted December 26, 2006

Q I was injured on July 31, 2003 when I was struck by a cyclist.    I was 40 years old at the time of injury and am female.  The handlebar struck me directly in the lower abdomen and I was knocked to the ground.  I was hit with great force as I didn't even see the cyclist coming and so my abdomen took the full force of the impact.  To date M.R.I.'s and C/T scans all reveal negative findings.  After two and a half years and a third attempt at physiotherapy, the physiotherapist made a diagnosis of an iliopsoas contusion.  She proceeded to treat my injury for 3 months, and I actually became worse.  I suffer from constant abdominal pain on the right side and suffer severe low back pain and constant leg numbness and foot ache.  My own physician insists that if this was a muscular injury it should have healed after 4 to 6 weeks of its original injury.  I have become increasingly frustrated with the lack of care I am receiving and my physician has even suggested that this is a psychological condition!!!!!!!  Is there any form of diagnostic testing that can reveal muscle and soft tissue damage?   Because this is a work related injury, the lack of success with diagnostic imaging is seriously jeopardizing my benefits status.  I have tried to remain working since the onset of my injury but repeatedly have to go off work because of the pain that I suffer.  I am at a loss as to what to do next and my Dr. seems to feel he's done all he can for me and has no desire to investigate or pursue this any further.  Any suggestions from you would be greatly appreciated.

A This is a complex clinical situation.  You were struck on the side where three muscle groups cross like weaving on a basket.  They surround internal organs.  The iliopsoas is very deep and at that level fairly midline towards the spine.  I agree with muscular injury, but the abdominals do not refer pain down the leg.  An older test called thermography is not very specific, but can give an idea what superficial muscle groups were injured as they have a temperature gradient that will distinguish the inflamed muscle from normal functioning muscle.  I would start there.  A nerve conduction study of the nerves to your legs and feet may be beneficial as well.  I think that you must have been thrown off the bicycle and the sacral-iliac junction may be malaligned, and if so a chiropractor or osteopathic physician may be of help with an adjustment.

Thank you

I wanted to thank you for taking the time to respond to my concerns so quickly.  I will mention your suggestions to my physician although given that the thermography is an older procedure it may not be available to me.  I am Canadian and although I live in a city of over 100,000 we only have one regional hospital. I do receive ongoing chiropractic and he is my most helpful and attentive health care provider.  My physician's lack of attentiveness to the abdominal injury however makes is difficult to receive a successful treatment program that includes all aspects of my injury.
 
Once again I truly appreciate your input and interest in my situation.

 


Posted December 26, 2006

Q My son is 11 years of age and his left knee often totally collapses on him. He cannot hop on his leg and cannot extend his leg to the full horizontal position, I wonder if you could give any guidance.

A A knee that collapses on an eleven year old child is of serious concern.  At the minimum he should undergo a plain X-ray to rule out bone lesions.  As I have limited information, if it is the knee joint proper, than an MRI is better for visualizing any internal derangement.  A consultation with a pediatric orthopedist first, and should it involve the nervous system (which I doubt based on your description) a follow up with a neurologist would be beneficial.  Hope this helps, but your son needs to be seen by medical professionals.


Posted December 26, 2006

Q I had a micro-disectomy removing only 20 percent of my disc L5-S1  from herniation 10 weeks ago 10/10/06 ,Is it to early for me to start golfing again?

A I would defer you to your orthopedic or neurosurgeon on the return to golf activity.  The problem to predict is difficult as only the surgeon knows the extent of the disc problem.  The golf swing in itself is capable of creating significant force on the spine to cause a disc herniation, so the sport have implications on spinal biomechanics.  Unfortunately, I can't help you in this individual situation.


Posted November 16, 2006

Q 5 years ago I started having strange sensations in the middle and index fingers of my right hand.  The pain moved down slowly and I was diagnosed with tennis elbow.  Over time the pain extended clear up my arm to the top of my shoulder.  My neck started hurting in the last year (much discomfort) and then I recently started experiencing tingling in my hands.  I was referred to a physiatrist who did an MRI and told me I have small herniations at c5 c6 and c6 c7.  The EMG showed beginnings of carpal tunnel  
 
He prescribed a 6 day steroid treatment that did nothing. He also prescribed valium , perhaps since my trapezius muscles are unbelievably tight.  I told him the pain is exacerbated when looking to the left (for instance listening to someone talk at a meeting who is to the left of me) and also when driving for more than 30 minutes at a time.
 
He acted confused when I told him I was still having neck pain a few weeks later at a follow up visit.  He prescribed more steroids.  Should these herniations not typically be causing pain?  I do see a personal trainer 2X a week for weight training.  Are there exercises I should be avoiding?  Should I see a neurologist or an orthopedist rather than a physiatrist?

A A physiatrist was an appropriate physician to be evaluated and treated.  In your case, a loss in range of motion may be a consequence of muscular tightness in response to a disc protrusion.  Not knowing the extent of the disc protrusions-herniations, if the EMG NCS (electromyography and nerve conduction study) showed a nerve compression in only the wrist, then the nerves near the cervical (neck)) spine are not irritated.  I would suggest an osteopathic physician to assess for manual adjustment-manipulation.  Should you not have a physician of this specialty, then an experienced chiropractor may be of benefit.  I would not recommend any more cortisone medication, although an anesthesiologist may be helpful with a localized epidural corticosteroid injection into the disc protruded material.  Additionally, a referral to a physical therapist would be helpful as well.  You may try to consult with your primary physician and review these options. 


Posted November 15, 2006

Q I have asked my personal doctor this question on several occasions and he doesn't appear too concerned over it.  However, I am and want to find out what the problem is and how to correct it. 

I have large knots approximately 1-2 inches below by knee caps.  They protrude about 3/4 inch from the leg bone.  While they do not cause me any pain, I cannot do any work on my knees.  The pressure of my body weight on my knees causes excruciating pain on the knots.  I figured they were some type of calcium deposit but have not been able to locate any research on the net that explains what they are, what causes them and how I can get them removed.  Could you please help? 

A If you were a teenager, I would venture to make a good guess that you have Osgood Schlatter's disease.  This is a condition where the patellar tendon attaches to the top of the tibia bone and is slightly pulled away from the bone by jumping in sports.  Very common problem, but viewing your employment status, this is probably not the answer. 

First of all it sounds like both knees are equally involved.  If appears to be stable, not growing in size, thus probably not an infection. It sounds like it doesn't affect other medium or large joint areas, therefore not suggestive of inflammatory arthritic conditions.  If you kneel often, such as rug installers or tile setters, the bursa or "water sacs" around the patella may become inflamed and fill with fluid.  This could be one cause. 

However, you need a diagnosis, as this will establish a treatment plan.  Two tests can help, the first an ultrasound will determine whether it is fluid or bone.  Then an MRI can determine what tissue type it is. I believe that these tests are reasonable.  Discuss these options with your physician.  If you would, write back and let me know what was the diagnosis.


Posted November 10, 2006

Q What does it mean if an infant doesn’t get the optical righting reflex on time?  I see an infant for therapy and she is now 7 months – still without the reflex.  I am concerned for her vestibular system and was wondering if there is anything I can do to help her get it and/or wondering if this is indicative of any disorder/future problem I need to watch for?

A Thanks for your inquiry, but it is out of my scope of expertise, as pediatric neurologists would be the medical specialists for this type of question.  Your infant patient must have other neurological impairments, a thorough eye exam should be done, examination of tonic symmetric and asymmetric neck reflexes should be checked, and the overall clinical pattern may establish a diagnosis.  A genetic medical specialist should also be considered to help with diagnosis.  Once a diagnosis is made then the treatment plan and outlook can be developed. 


Posted November 10, 2006

Q I am 63 years old, have had 6 children.  I had a "tummy tuck"  @ 20 years ago.  I had gallbladder surgery (laparoscopic) 2 years ago, and have no muscle support in my abdomen.  I have been experiencing pain in my groin area, especially on the right side  whenever I'm on my feet for any length of time. I live in a small town with limited medical facilities.  We do have a physical therapy dept at our small hospital.  My question:  could a tummy tuck become "undone" during gallbladder surgery?

A You've had multiple procedures on the muscle wall of your abdomen, but groin pain is more likely referred pain, or pain from structures in the inguinal area.  Referred pain means that the source of the pain in not in the area where pain is experienced.  In your case, a chiropractor should evaluate you for a sacral-iliac subluxation.  On the other hand the most common groin pain is an inguinal hernia, often called a "sports hernia" in individuals who lift heavier weights.  There are other structures such as the inguinal ligament, or even in rare cases, lymph nodes may be inflamed and can cause pain.  You should also follow up with your primary physician and gynecologist to ensure that you've had a comprehensive evaluation of your pain.  I hope this helps. 


Posted October 31, 2006

Q What do I tell my 14 year old daughter:  As a freshman in H.S., she is the best runner on her track team.   At every competition she has improved her personal best time.  Yet prior to every competition she is so anxious that she has diarrhea the whole day (the meets start at 3 p.m.), and tonight, prior to the season finals, she is crying uncontrollably.  She is afraid that she won't do her best.  Anyway, obviously she will benefit from counseling, and that will happen asap, but in the meantime, from a sport's perspective, what can a mother do to help them when they are so upset? 

A As you describe her clinical picture, it seems that anxiousness and apprehension create turmoil on her physical body in the form of gastrointestinal consequences.  Your daughter may benefit from a professional psychologist to identify the triggers or causes of this pre-competition anxiety.  A psychologist cannot prescribe medications, but can help with the diagnosis and alternative, non prescription medical advice.  The second conservative approach is to consult a person with expertise in Natural Medicine.  There are natural remedies to help calm the nerves, one of which is an homeopathic blend called "Rescue Remedy" and is quite effective.  Based on the personality profile identified by the psychologist, there are herbal supplements for anxiety and over-reaction, one of which is "Holy Basil".  Again, I would refer to a professional in establishing what supplement your daughter should try.  I am assuming that her diarrhea is only related to pre-competition.  If she has diarrhea more often, you may need to contact your primary physician or a specialist, a gastroenterologist.


Posted October 30, 2006

Q I am a 52 year old tennis enthusiast, runner and basketball player.  One month ago I had posterior knee pain, primarily lateral near the fibula following a singles tennis match two days after the match.   I  have treated it with deep tissue massage, diathermy, electric muscle stimulation (I am a chiropractor).  It seems to reduce in symptoms with the treatment but everytime I play basketball, it reacts and I gimp for 2-3 days following.  No diagnostic studies.    Full ROM, mild pain with full flexion, knee stability tests are negative, no swelling.

A Active individuals in sports without contact trauma can torque the knee joint and create a tear of the meniscus (cartilage).  If the tear was large, swelling would be evident.  If it was an extension or a pre-existing tear or slight tear, swelling may not be detectable.  There are other structures that can be affected.  The lateral supporting ligament is the lateral collateral ligament that can stretch and cause pain.  This would be localized and would respond to modalities for transient relief.  As this does interfere with your avocational activities, I suggest an MRI of the knee for the definitive diagnosis.  I hope this helps you.


Posted October 30, 2006

Q I am 43, 160 lbs, and am pretty active.
In 1991 I broke my neck and had a fusion on 3 and 4. in 2002 I broke it again and had 5 and 6 fused together.
I am now having lots of burns and stingers on my left thumb the muscle was dying and I had cortisone shots to relieve the pain. Its doing ok now, but now it seems to be happening to my left elbow, forearm area. Is it possible that the screws that were put in on the fusion, could be affecting the nerves coming out of the 6th vertebra? or should I fell lucky that I am still walking and live with it?

A The pain in the forearm and elbow may be coming from structures of the neck.  Yes, you are lucky, but you need further investigations with an enhanced CT scan, or if titanium plates and screws, an MRI may also be feasible.  You also need a neurologist to assess the nerves of C5, C6, C7 done with and EMG NCS (nerve conduction study).  Revision of the graft and fusion may be necessary based on the findings of these objective tests.


Posted October 30, 2006

Q I read your article about pitching velocity and weight training.  Do you have any sample weight training workouts that you could recommend for your program?

A I am sorry, I do not have any workout training schedules.


Posted October 25, 2006

Q I am a physician working on a project on golf physiology for some colleagues, and am trying to figure out calorie expenditures for the golf swing.

I know there are websites that calculate calories for all sorts of activities, but I need to know specifically how many calories our muscles burn during one swing.  The calorie counter calculators give you “calories per unit time,” and don’t explain their assumptions for how many swings, etc.

So, if it takes 2 hp (1500 watts) to swing a driver at 100 mph, how many calories will the muscles burn in generating this power?  And since horsepower or watts is energy/time, is the 2hp produced continuously over the 1.5-2 seconds of the swing, or only the half second or so of the downswing when maximum speed is accumulated, etc.

Thanks for any help you can provide.

A Great question, short answer I don't know.  I will refer you to Dr. Murray Maitland and Dr. David Lindsay, both originally from Univ. of Calgary.  Dr. Maitland's email is mmaitlan@u.washington.edu  I hope he can help or direct you in the right direction.  Should you get the answer you seek, if you would email me with this answer, it would be appreciated.

Dr. Murry Maitland writes ...

 Let me stress that this not my area of study and there are good reasons why a person might want very precise measurements. David Lindsay has a better background in the golf literature and is nearby to some marvelous muscle physiologists.  
 
I don't have the real numbers or methods used in the previous studies, but I would like to start by asking how precise you want the values. For example, I have previously calculated the energy used by various weight track spikes, and I have been the subject for several running experiments to look at O2 uptake.
 
In running, cycling and paddling a reasonable estimate of the Calories per hour would be around 1500 for a good athlete. I have personally be involved in experiments of shoes that can change my efficiency (energy cost at a particular speed) by 5%. This is a big deal to competitive athletes.
 
In golf, the energy cost from walking or carrying the clubs far exceeds the energy cost of swinging the club. If we take your numbers (1 second approximately, 1500 Watts, 80 swings per 18 holes) and use www.onlineconversion.com/energy
 
1500 Watt*seconds*80 =120000 Watt*seconds=28.7 kilocalories or approximately 29 Calories
 
If we consider muscle to be approximately 14% efficient, then we end up with about 207 Calories for 80 drives. That is equivalent to 2 ultralight beer or 1 porter. 
 
Since the acceleration of body mass is perhaps more important than the acceleration of the club in energy cost. The energy cost is likely to vary with golf technique especially the amount that the center of mass is raised or lowered during the swing. The acceleration of the torso in rotation is likely to vary as well.  

Dr. David Linsay writes .....

I am pretty familiar with most scientific golf literature but have never come across anything as specific as the caloric expenditure of a single golf swing. Cochran & Stubbs do talk about the 2-3 HP requirement for generating the 100 MPH downswing which takes 0.25 of a second. Murray's calculation should work given some refining of the numbers. There are several studies that have collected data on the overall calorie expenditure during a typical golf game. I'll ask one of golf biomechanists to see if he has heard of anything.


Posted October 25, 2006

Q I have been searching for answers to my medical problem for almost 5 years now. Unfortunately I have found no relief and the pain continues to increase. At this point sitting is very painful in the lower right side of my back. Across the facet joint area. Pain extends over to my right hip bone. Also continues down into the buttocks (that area is tender to touch also) down the back of the right leg, into the calf. When I am on my feet for more than 15 minutes the pain travels into the heel and the left leg begins to throb and burn.

I also experience pain in front below the right hip bone. That pain is from a torn iliacus muscle that showed on an MRI 1 1/2 years ago. I am told it is hard to treat.

My question is: Can the torn iliacus muscle be causing all the pain I have just described in the lower back, etc.? I am getting mixed opinions on that. I just need to find someone with an answer and give me some relief. Keep in mind I cannot take ANY pain meds. I have also been through pain management 3 times.
What kind of doctor should I be seeking at this point.
If you need more info feel free to ask.

A This is my first experience of a torn iliacus muscle.  How did you tear it?  Did it tear at the rim of the pelvis of in conjunction with the psoas muscle.  Either way, I suspect you have other complicating biomechanical malalignments.  I believe you have a malaligned sacral-iliac that causes sacral notch pain and causes torque tension on the gluteals and piriformis muscle.  Read the article on the piriformis muscle and its entrapment of the sciatic nerve. 

Next, what to do.  You need a good experienced osteopathic physician or experienced chiropractor to re-align you.  You also would benefit from a deep ilio-psoas stretch as in the technique of Active Isolated Stretching developed by Aaron Mattes, who was my clinical director at my clinics.  Other than this, I am short on other options. Please write back with more information on the circumstances of your initial injury and maybe I can shed more thought into the problem.


Posted October 25, 2006

Q I live in a small community so testing is always a long time I had a lower back injury 5 yrs ago which was being treated by massage and stretching and seemed to escalate into left shoulder problem and right leg ciatic nerve at times. The massage therapy seemed to keep me going as the more I stretched the tighter I got. About 2 yrs ago while at physiotherapy the therapist used tenss on my shoulder as it was bothering me .
 

He put heated weight across shoulders and after 30 seconds I was screaming it felt like he broke my shoulder , he stopped treatments at that time but the next morning my complete left side numbed and I was in emergency as they were looking at heart attack or stroke. My left face and eye area still feel the numbness feeling as well as my left heck is always tight pulling feeling.

 

A year later I finally had back, shoulder x-ray and ct scan of head .Results were negative. This year while just walking at work one day my shoulder started hurting by 5pm was in emergency passing out from pain, they put me on oxycoton, off work two weeks , 6 weeks later had MRI of head and neck for pinched nerve( negative) Doctor is now referring me to physiatrist( year wait) .Should they be able to detect problem or is this just a case of ??

A Based on the information you provided for me, it sounds like a tightness in the lateral-posterior neck shoulder complex.  Your left shoulder, upper trapezius muscle may appear swollen or "muscular" when you compare it to the non-affected side.  You may also experience loss on internal and external rotation of the left shoulder. 

Pain may also be found in the front of the left shoulder at the AC joint and at the Clavicle-Sternum.  I believe you have a subluxation (mal-alignment of the clavicle which attaches itself into the joint of the sternum and acromion.  An experienced chiropractor or osteopathic physician may be the only specialists to help you in re-alignment.


Posted October 25, 2006

Q My 83-yr old father can walk but cannot lift himself out of the chair or bend his body. What should I do?

 

A Based on your information, your father needs an MRI or CT scan of his spine to identify severe spinal stenosis which may need surgery.  He also needs a nerve conduction study to rule out other problems such as neuropathy due to disease or nutritional states.  Ankylosing spondilitis is also a condition which cortisone may help.  Hope this helps.  Let me know what the doctors find.  I would start with a neurologist first.

Posted October 25, 2006

Q For the past 3 months I have been having symptoms of my tongue burning/tingling and slight tingling in my left forearm to my little finger. The symptoms would come and go, mainly present by the end of the day and would subside when I would lay down/sleep.  The symptoms have finally subsided to a certain degree. I have also reduced some stress in my life and have not been cycling or running for the past 3 months.  All blood tests, brain MRI and x-rays are normal, no MS or other diseases present.   I recently had an MRI of the cervical spine without contrast.  The impression from the Doctor is as follows:

  1. At C5-6, chronic degenerative disc disease with posterior marginal osteophytes causing moderate to severe left foraminal stenosis
  2. At C6-7, mild degenerative disc disease.

My question is…are the symptoms I have a direct result of the degenerative disc disease at C5-6?  If so, what can I do to improve/strengthen the area in question?  I am an avid bicycle rider and have refrained from riding the past 3 months. 

A I do not believe your symptoms are related to the cervical disease, especially the tongue burning.  Tongue burning may be an early zinc deficiency syndrome.  The numbness in the forearm may be from an irritated ligament or nerve in the C6 area, but you don't have the classic description.  I would start with an intuitionalist or even a homeopathic physician.  Let me know what they find.


Posted October 12, 2006 Shin Splints

Q I am a 23 year old male.  I found your website online when I was searching for some information on shin splints.  I have been running for about 3 months and I am starting to have a good amount of pain on my lower legs.  I have found some information saying that I need to rest, find some different shoes, but I am wondering if I have a mechanical problem in my running form.  First off I would like to know if I would benefit seeing you and also I was wondering if there is anything you could tell me to do through email.  Ideally I want to start training for triathalons but this is definitely hindering my effort. Thank you very much for your time.

A Shin splints traditionally have been treated with the rest and anti-inflammatory.  There is value in assessing for mechanical-structural malalignments.  Certain gait patterns are prone to develop shin splints and there are specialty shoes for athletes that correct inversion-eversion or supination-pronation.  Although this is the basic education of shin splints, I have found in my clinical experience that running hard on the heals causes the sub-talar/heal to adhere causing tightness in the lower leg compartments.  The more anterior subluxations can affect the tibialis anterior muscle distal attachment and add tension to the strong dorsiflexor and result in straining this muscle.  Chiropractors, osteopathic physicians and manual therapists try to release these small foot joint immobility and correct for proper muscle function without strain on the muscle.  Assess if one leg has shin splints or both.  If it is only one, then an anatomical mal-alignment is probable, whereas if both are equally involved, then consideration should focus on equipment-shoes or gait pattern running technique.  Hopes this helps you.  I see by your email address that you are local.  Should you need to see me, I will be glad to provide you with a more objective diagnosis and treatment plan.


Posted September 12, 2006

Q I am a 30 year old basically healthy male.  I always suffered from stiff muscles--but did stretch out--I had discectomy 5/18/06 for herniated L5.  Prior to that I had 6 weeks of Physical therapy, 1 epidural shot given by an anesthesiologist who only does that.  My symptoms never really disappeared.  the neurosurgeon requested another MRI which revealed a reherniation of the same disc and is suggesting he go back in and remove more material and get more aggressive.  my family wants a second opinion.  The pain is different than first time--but basically in same area.  I did have a bed that was 10 years old--I got a medium "pillow" top bed.  During this episode I've been staying at my parents home.  What should I do?

A A microdiscectomy "shaves" the disc material, but on occasion, the herniation still remains or even extends.  You did not describe what was different in your pain presentation.  Based on what you presented in your question, I would seek a second neurosurgical opinion to confirm that another surgery would be beneficial.


Posted September 11, 2006

Q My 18  year old son has begun to complain of a soreness in his pitching  arm...do I trust his college coach/trainer to tend to him or do I take him to a sport medicine doctor or physical therapist.? Is this normal use tenderness or more?

A Your question is relevant in that all pain and soreness need to be examined and treated.  If the soreness is new and localized, you may proceed directly to physical therapy.  Should there be any associated numbness or weakness a sports medicine physician, a rehab physician (physiatrist) or osteopathic physician are the best choice.  I would also like to direct you to Dr. Mike Marshall's web site for a more thorough explanation of types of injuries and thier biomechanics.  His web site is www.drmikemarshall.com .  I hope it is minor and your son resolves his pain. 


Posted August 28, 2006

Q My son just turned 15 and has an injury to his Iliac crest.  He is very athletic, runs and bikes regularly and participates in track in the spring and soccer throughout the year.  Last spring he participated in running events up to 400m and the high jump.  The front point of his hips were tender and his back bothered him at this time.  After the season these symptoms decreased and went away.  He played soccer during the summer with no lower back or anterior hip pain. Three weeks ago he began to train in kicking for the upcoming football season.  He did not train for kicking since last fall.  Initially he complained of lower back pain, specifically to the Iliac crest.  The following week soccer two-a-days started and the pain got worse.  The schools trainer diagnosed muscle tightness and doing to much to soon.  Football kicking was eliminated, extensive stretching applied and soccer practice was limited to minor participation.  After one week and no change a sports medicine Dr. was seen.  After x-rays and evaluation her diagnosis was extreme muscle tightness ("an accident waiting to happen") and prescribed Relafin.  Continuation of stretching was recommended.  After another week there is still no change.  The top of his Iliac crest is not tender to the touch but is where the pain is coming from.  Any suggestions?

A Thank you for your inquiry.  I am glad that you are specific in your diagnosis.  I will try my best with the information at hand and without examining your son.  Kicking and running events that cause pain in the anterior pelvic rim are most commonly associated with strains of muscles that attach along the anterior-superior iliac crest, the most common being the sartorius muscle.  Your son would have difficulty crossing his legs into a figure "4" position, and possibly pain medially, just below the knee joint.  However, these sprains respond quickly to rest followed by stretching.  Another possibility is a psoas minor associated sprain.  This muscle is deeper in the lumbar-pelvic area and attaches to the superior anterior pelvic rami.  You can find my article on the psoas minor muscle in the football injury section.  The more confusion or uncertainty of a specific diagnosis implies more than one structure to be contributing to the problem and symptoms.  An additional problem may be with a sacral-iliac malalignment that chiropractors usually manually adjust back to proper position.  These are some areas to explore and help establish a more definitive diagnosis for your son.  Once an accurate and specific diagnosis is made, the treatment is usually successful within a short period of time.  If you have more questions, please write back and maybe give me more specifics to the mechanism of injury--"How did it happen?"

Q...Thanks for your prompt response to my inquiry.  The injury happened when he started training for football place kicking.  He was supposed to work on fundamentals and mechanics, to ease into the activity, but did to much to soon.  He trained last fall and kicked up to 50 yd. field goals, but had not worked on it since then.  His main sport is soccer, which he plays off and on throughout the year.  He is left footed and the pain started on that posterior side. The following week during soccer two-a-days the pain got progressively worse and developed on his right side also.  One particular day they did ab crunches on pavement and it got significantly worse.  He has been static stretching with a trainer for 2 weeks with minimal change.  I have decided  to try some dynamic stretching and massage therapy which seems to be working.  Tomorrow he will see a chiropractor. 

A...Thanks for the information.  It sounds more like a biomechanical problem than a disc herniation or facet joint problem.  A good chiropractor is a good start.  Dynamic stretching in most cases is better than static.  Techniques such as Active Isolated Stretching (AIS) or ART are probably two of the best techniques.  Pleased keep me updated on his progress.


Posted August 25, 2006

Q In July of 2005 I had a spinal fusion at L5-S1.   My latest CAT scan (done a week from last Friday) my doctor had his nurse call and say "the fusion isn't progressing like he wants it to?  He will see me in December for my 18th month check up.

How long does it take for a fusion to heal?  My pain level has not changed much...I am still working.  Please advise

A A spinal fusion is done with your own bone graft or a cadaver.  Your own harvested bone is more likely to take, but is more painful to the buttock muscle attachments.  There are instances that the bone doesn't adhere to the vertebral bone, making the fusion less solid, but yet it may be functionally adequate.  Your surgeon I believe is trying to use time to assess your overall healing ability.  In regards to your pain, your surgeon probably mentioned that the surgery is for strengthening the spinal vertebrae and may not alter your pain.  You may have to look at other sources for your pain such as facet joints of deep ligamentous sprains.  A doctor of osteopathic medicine can evaluate you for spinal adjustments that he or she can perform.  If you need more information, please provide some more specifics to your condition. 

Q...I do appreciate your quick response to my inquiry.  My doctor has ordered a "bone growth stimulator" to aid in the healing process. 
 
My main concern is, something going wrong with the hardware.  He has indicated to me that so far it is fine.  He has also indicated that if my fusion doesn't take that he will have to do the surgery again.  That really scares me.
 
Did I understand correctly that the fusion does not take away the pain?  I was not told this, I was told that I may feel immediate relief.  I did develop an infection after the surgery and had to be re-admitted to the hospital.  So I assume this may be the cause of the lack of fusing. 
 
My doctor did remove a bone graft from my hip, but the main surgery went though my abdomen.  When I was readmitted to the hospital, the doctor tried to have an MRI.  I must say it was VERY painful....felt like something was being ripped from my stomach.  They tried this three times, all with the same results.  My doctor indicated that he had used titanium hardware, and doesn't understand why I  had that reaction.  I have had many MRI's done in the past and NEVER had that happen and I am not claustrophobic.
 
Have you had much success with a bone growth stimulator?  I have been in constant back pain since April of 2001.  I have undergone several series of injections and a lot of physical therapy....to date, nothing much has worked.

A...Your recovery was complicated by an infection.  This in itself may be the reason the bone fusion did not take.  The work up was complete, except that titanium does not cause the magnetism for the MRI.  I wonder if another piece was used in the wire or screw that caused the shifting you felt with the MRI.  You may want to "google"  metals that are contraindicated for an MRI.  I would suggest you do not have another MRI until you discover what all the metal components are composed of.  Finally, the bone stimulator is a great idea.  It is a wait and see process to assess the degree of healing.  Until you "heal", it is unlikely that you will identify the source of your pain more specifically. 


Posted August 24, 2006

Q I read the article about pitching velocities.  I am still unclear as to weather bench pressing helped the athletes increase throwing velocity.  I currently throw 86 MPH and I am trying to get my velocity up to 90 MPH.  I do follow a throwing program with an overweight and underweight ball like you prescribed, but would bench pressing in addition to this help or hinder my velocity?  I was thinking of bench pressing about 55 percent of my 1 rep max at high speeds to build explosiveness.

A Throwing mechanics require strength, but also balance in muscles.  Over strengthening one muscle group may even hinder your mechanics slightly.  You have two types of muscle fibers, slow and fast twitch.  One type of strengthening will over develop the slow twitch fibers. Using weighted balls or smaller weights in simulation
motion is probably more effective to increase your speed.  The work in the weight room is important early in the pre season to increase your muscle strength and endurance.  I would strongly suggest that you contact an expert on this subject a former Cy Young pitcher with a degree in kinesiology and pitching biomechanics, Dr. Mike Marshall at
www.drmikemarshall.com  and email him this question as well.  He responds to the emails very quickly.


Posted August 22, 2006

Q I have been experiencing "clicking" in my hip & lower back whenever I walk. It isn't painful, just annoying. Any ideas?

A Clicking sounds without pain are usually not of much concern.  The sounds are usually related to tendons and joints moving and releasing pressure off each other.  The chiropractors have better explanations on the cause of "popping" and "clicking".  Surgeons may explore these sounds if they had surgically implanted some type of metallic device to assess malfunction.  Sorry I couldn't be more helpful.


Posted August 21, 2006

Q I have been having hip pain.  Where would the point of pain be if it is actually in the hip joint and not the surrounding tissues?

A Hip pain can have many causes.  The first issue concerns any injury or trauma.  If direct trauma from a fall or impact to the hip area, the outer muscles and bursa will be traumatized.  Common problem is trochanteric bursitis.  Chronic hip pain from age may be as a result of inflammatory arthritis.  If one consumes too much alcohol or have too much cortisone, the head of the femur (hip) may deteriorate and need replacement.  Occasionally, pelvic and low back structures that are inflamed may refer the pain down to the hip.  Osteopathic physicians and chiropractors are good in determining the source of your pain.  Hopefully, their evaluations will include an X ray of the hip.  If they determine referred pain, then an MRI may be helpful.  There are other less frequent causes of hip pain such as bone tumors, infections, and partial dislocation to mention a few, but these are of low probability.  If you could, please provide me with more information such as onset of pain, your age, pain pattern, aggravating and relieving factors, that may guide me to a more specific diagnostic approach.


Posted August 7, 2006

 
Q I can only walk on a flat surface for a limited time.  Walking up hill I fall forward, but can walk up hill backwards much easier. Walking generally around the house I manage quite OK. When out with friends I try to keep up but get so tired and out of breath with trying to keep upright that I have to give in.
Could this be my psoas?
I have been to many Doctors, but no one has been able to help me.
Any comments would be very much appreciated.
 
I am 68 years of age, weigh 60 kilos and I am generally a very active person and have generally had good health. (I know and appreciate that in this respect I have been very fortunate)
July 2002 was the first time I realized I did not have the strength to carry anything in front of me without feeling I was going to fall forward and had to stand still, straighten my back and really work at the strength in my legs and stomach to go forward. (I can carry on either side only not in front).  Also, if I am standing at the sink, for instance, I lean to the right without realizing this is happening.  Then in October of the same year I had symptoms which were finally diagnosed as Myasthenia Gravis.

 

The Neurologist I am under says these two conditions are not connected.
I have not had an MRI test.
I am not quite sure what you mean by 'neurological evaluation' but my neurologist did give me the usual arm, leg and eye reactionary tests. And all was well.
No one has an answer for me except to say it is my stomach muscles.  I have done exercises for this but it doesn't seem to help.
Xrays I have had taken are as follows:-
2003
CERVICAL SPINE - There is advanced narrowing of the C6/7 disc space with anterior spurring of the vertebral bodies consistent with chronic degenerative disc disease at this level.
THORACIC SPINE - There is a mild thoracis scoliosis. Minor spondylotic spurring of the vertebral bodies is noted about several lower thoracic disc spaces.
LUMBOSACRAL SPINE -There is marked narrowing of the L4/5 and L5/S1 disc spaces with vacuum phenomena indicating advanced chronic degenerative disc disease at both levels
2004
CT CERVICAL SPINE
FINDINGS - Examination from C3 through T1
Minor uncovertebral and facet degeneration is present in the lower cervical spine.  This results in mild spondylitic foraminal narrowing at C6-7 bilaterally.
Remaining invertebral foramina appear adequate.
The canal dimensions appear adequate
No disc protrusion or paravertebra pathology identified as an alternate cause for current symptoms
No significant incidental pathology detected.
COMMENT; Cervical spondylosis, with potential for C7 neurology bilaterally.
2005 - Chiropractic evaluation DJD
CERVICAL SPINE
There is loss of the normal cervical lordosis with minor loss of disc height at C5/6. There is moderate loss of disc height at C6/7 with subchondral sclerosis and marginal osteophytes particularly posteriorly. Minor diffuse degenerative changes are seen within the facet joints.  There is a large moderate right C6/7 bony foraminal stenosis.
THORACIC SPINE
There is mild scoliosis convex to the right in the lower thoracic spine and scoliosis convex to the left in the upper thoracic spine. There is generalized osteopenia but no crush fractures are seen.
LUMBAR SPINE AND PELVIS
There is loss of the lumbar lorosis with moderate loss in disc height at L2/3 to L5/S1.  Marginal osteophytes at L5/S1.  The S1 and hip joints are unremarkable.  There are prominent changes at the L5/S1 facet joints.
 
Sorry this is so long but I have included all because I don't know what might be useful.

A Yes a very tight psoas may be a major contributing factor to your problem, but I can't state that with sufficient certainty.  I would need more information.  How old are you?  When and how did your symptoms start and progress.  Have any diagnostic MRI testing or neurologic evaluations been completed.  Do you have any other medical problems such as diabetes, neurological conditions or spinal stenosis (in the lumbar spine area) specifically.  These will help me understand you condition better, which may open more suggestions for your clinical condition. 

A Thank you for adding more information.  Neurologists have given you a clinical diagnosis of Myasthenia Gravis, a proximal weakness of muscle.  You are correct in asking for a Lumbar spine MRI as you need to assess for spinal stenosis which will position you spine forward to keep the spinal canal open.  Additionally, at your age, your doctors may want to explore the possibility of Polymyalgia Rheumatica as this presents as proximal muscle weakness.  Finally an MRI of the brain may help rule out a lesion in the brain to account for the leaning and postural changes.  I really doubt the psoas muscles alone can cause your clinical presentation.  Hope this helps you on your path of a diagnosis.

Posted August 1, 2006 - Baseball Pitching

Q I took my 11 year old son to see our local doctor a month ago since he was complaining about his arm hurting about 3 inches below his shoulder on the outside of the arm.  The doctor took x-rays and thoroughly evaluated my son but could find nothing wrong.  His conclusion was that he may have tenenitus due to pitching during the season.  Could there be something else ?  Is it normal for his arm to still hurt when throwing hard in that same area?

A Your son probably developed a strain of his brachioradialis muscle as a result of his pitching mechanics.  Amy muscle strain involving the attachment point of the tendon is called tendonitis, a generic term for muscular strain.  I have worked closely with Mike Marshall a former Cy Young pitcher who also holds a PhD degree in biomechanics of baseball pitching.  I think that it would be of great benefit to you to write Dr. Marshall on his web page www.drmikemarshall.com.  He is great about returning emails.  If you have any other questions, please feel free to write back.


Posted August 1, 2006

Q I twisted my right ankle running down a flight of stairs.  The external swelling has gone down but I have a lot of pain from the outer side of the ankle, through my calf on the outer side, to the knee.  Is there a tendon that runs along that route? 

A Thank you for your question.  The short answer is yes, there are a few that control the movement of the foot and toes.  These muscles and their tendons attach above and below the level of the ankle joint.  If the ankle's small bones are in alignment, then these tendons usually don't present with a problem.  With a moderately severe ankle sprain as you describe, I would guess that you may still have a slight subtalar shift that limits your ability to turn your ankle outward without pain.  Compare both of your ankles in range of motion.  If the unaffected one has more range, then you may need a chiropractor to adjust your ankles back into alignment.  In regards to the various tendons that pass along the lateral or outer ankle area, you may find them on any anatomy site on the web.


Posted July 30, 2006  - Spine

Q I emailed you some time ago regarding my back. You advised me to go to a chiropractor. I have been seeing a chiropractor 3 times a week for several months.

I had a spinal fusion (L5-S1) 2 years ago. I go to physical therapy 3 times a week. I also stretch at home. I have tried all types of medications. I tried acupuncture. The problem is my muscles in the buttocks are tight and constantly spasming. The doctor and physical therapist have told me the muscles are getting worse and can’t understand why this is happening. Two months ago I left my job in the hopes my condition would improve. There is no change in my condition. When I don’t go to physical therapy, I am much worse if I don’t go to therapy. Because the muscles are tight and spasming, I have persistent nerve pain.

I did some research on the internet and I read a few articles about Botox being used for this sort of problem. I would like to try an injection. Do you think this would possibly help? If yes, would you do the procedure?

A With a spinal fusion at L 5-S 1 it is more difficult to correct a sacral-iliac malalignment by chiropractic manipulation.  With the information you have provided, you may want to try Botox injection if the spasms are unmanageable in spite of other therapies.  I think I would proceed with the Botox as it offers a plausible solution without severe adverse effects.  When you consult with the physicians regarding the injections, they will review the clinical muscular and neurological state and give you their recommendations and contraindications if any.  Let me know how things transpire.

Posted October 12, 2006

Q... In July of 2005 I had a spinal fusion at L5-S1.   My latest CAT scan (done a week from last Friday) my doctor had his nurse call and say "the fusion isn't progressing like he wants it to?  He will see me in December for my 18th month check up.
 
How long does it take for a fusion to heal?  My pain level has not changed much...I am still working.  Please advise

A... A spinal fusion is done with your own bone graft or a cadaver.  Your own harvested bone is more likely to take, but is more painful to the buttock muscle attachments.  There are instances that the bone doesn't adhere to the vertebral bone, making the fusion less solid, but yet it may be functionally adequate.  Your surgeon I believe is trying to use time to assess your overall healing ability.  In regards to your pain, your surgeon probably mentioned that the surgery is for strengthening the spinal vertebrae and may not alter your pain.  You may have to look at other sources for your pain such as facet joints of deep ligamentous sprains.  A doctor of osteopathic medicine can evaluate you for spinal adjustments that he or she can perform.  If you need more information, please provide some more specifics to your condition. 


Posted July 29, 2006

Q I twisted my right ankle running down a flight of stairs.  The external swelling has gone down but I have a lot of pain from the outer side of the ankle, through my calf on the outer side, to the knee.  Is there a tendon that runs along that route? 

A The short answer is yes, there are a few that control the movement of the foot and toes.  These muscles and their tendons attach above and below the level of the ankle joint.  If the ankle's small bones are in alignment, then these tendons usually don't present with a problem.  With a moderately severe ankle sprain as you describe, I would guess that you may still have a slight subtalar shift that limits your ability to turn your ankle outward without pain.  Compare both of your ankles in range of motion.  If the unaffected one has more range, then you may need a chiropractor to adjust your ankles back into alignment.  In regards to the various tendons that pass along the lateral or outer ankle area, you may find them on any anatomy site on the web. 


Posted July 29, 2006

Q I want to try to get my players to turn their shoulders 90 degrees on the backswing without increasing the spaces between each shoulder blade...where would they have to turn from...the obliques, thoracic, where?...and should the women try to turn from the same place as the men?....
 
Are you at liberty to explain how Ms. Mann teaches proper positioning?...
 
I would love to have information that helps me identify my players anatomical variations (both men and women)...I mostly work with women players on the LPGA and Future tours and women college players from all over the states....thus the interest in women anatomy in the golf swing...
 
Doc, do you have any pictures that show the elbow angles of the women and how that creates the chopping motion you described?...I try to teach a more rounded swing that produces very little divots...
 
Thanks again for the info and if you don't mind, please send more...I look forward to your comments on the above...it is much appreciated...and valued...

 

A Thank you.  Your questions are excellent.  I will try to provide you with my present knowledge of functional anatomy.  In reality, demonstration and visualization is better than writing when describing motion, but I'll try.
 
The scapular distance has been explored, most notably by the Australian/ New Zealand biomechanics researchers.  They hypothesized that women are anatomically weaker and need specific strengthening of the parascapular muscles.  This would be feasible if the functional anatomy was the same as men, but it differs.  The range of motion of the shoulders in most women if greater than men due do the higher center of rotation.  This ability has no relationship with strength in the scapular/shoulder movements.  However, some women have functional spine movements that characteristically move like men.  Then these women have shoulder ranges like the men.  The "secret" is analysis of their "natural" spine movement is the essential key to understanding how to maximize the student's potential.  You can't effectively teach a low spine center mover the same as a higher spine rotator.  This is the concept I will bring into the golf community.
 
Carol Mann's positioning is simple, but requires a visual demonstration.  She prepares the woman golfer in set up the instructs to further "sit" into the position.  Again, this is a very small correction and needs close monitoring for the first few times so that the golfer creates a "feel" of the deep hip flexors and rotators--the basis of the "feel" men describe in the power of their hip rotation that initiates the downswing.  Most women and many men never experience this "feel" and as such develop compensatory movements, the most common being a lateral shift, which I term a lateral "slide" which takes away power, distance and actually leads to deceleration of the downswing.
 
To eliminate divots in the short term, without knowing anatomy, focus on club selection.  Women need high loft angles for their drivers 13-15 degrees, lighter shafts, and hybrids for their iron sets.  There are some prototypes of hybrids coming out in the next 12 months as well as a new patent designed shaft by John Hoeflich formerly from TaylorMade that may revolutionalize women golf equipment.  I have tested his prototype and the results were amazing in accuracy, distance and control. 
 
Another suggestion, if the women have problems with the "chopping" motion and your instruction is causing them to loose interest, but more importantly enjoyment of the game, then consider letting them return to "chopping" slightly and assessing more lofted equipment for them as well as a more appropriate ball, one that is not as compacted.
 
Well, I hope this helps you.  Again, as I learn more every day, I modify my understanding.  We have so much more to learn.

 


Posted July 27, 2006

Q I am a golf professional and tour coach living in Pinehurst, N.C....I just finished reading one of your articles that pertained to woman having different elbow angles than men...I was wondering if you had some time to go into it a little further...recently, I had a female player complain of elbow pain while training....I am concerned about this and any comments that you can share would be greatly appreciated and valued...I am particularly interested in how you think we as coach and trainers should work differently with men and women?...

A Thank you for taking the time to read my clinical articles.  Over the past twenty five years I have studied functional anatomy and biomechanical applications.  Men and women differ considerably.
 
First of all, the pelvis of a woman and man structurally are very different and the angles of their femur bone is significant.  The majority of the women need wider base stances and frequently do not have the "feel"  of the hip torque, unless you position their deeper muscle, the iliopsoas is a favorable firing position.  The only instructor I've come across that teaches a method for proper positioning is Carol Mann and she is proud that this is her "secret" teaching technique.
 
Next and most critical issue is that the thoracic spine and lumbar spine movements differ in men and women with an occasional overlap. Men tend to turn their spines at the mid lumber area, women tend to turn at mid thoracic.  Many studies in medicine have shown this, no one has put it into biomechanical application.  In fact I am writing an entire book on the subject that should shed light to why you need to know your students natural swing potential and adjust as an instructor to their anatomical variations.
 
Next, the women usually have a greater elbow angle that causes a slight imbalance in the forearm muscle tension leading to tendonitis.  Anatomically, this angle allows women to carry a baby more functionally in their arms and carry items alongside of their wider pelvic girths.  However, to throw a ball without a large arc is difficult for them.  Women softball players who have a large elbow angle can throw at higher velocities pitching, than men with straighter angles. 
 
Women also have more shoulder strains as a result of increased elbow angles as this anatomical joint influences the joint above it and below it.  Shoulders and wrists follow elbow pain.  On the contrary, women have less lumbar pain as their spine movements are higher up the spine.
 
Functionally, women have lower strength capabilities which influence their equipment choices.  Lighter clubs, lower frequencies and lower swing weights.  Due to elbow angles and type of spinal movement they strike the ball in a more "chopping" motion, creating greater divots, less distances and lower ball flights.  Their golf balls should be matched to their swing distances.  their loft should be increased across all their clubs, especially the driver.
 
One day, I hope to release a simple book to help instructors identify their student's anatomical variations.  I have worked with researchers and industry leaders in helping them create design changes, notably for women.
 
Recently, I am involved with testing a natural supplement for brain-muscle performance called MindDrive Sports Nutrition.  There have been a handful of infomercials released on the Golf Channel.  They plan to create another commercial explaining the product, its use and efficacy.  I like the product for teaching and play.

Posted July 15, 2006

Q I wanted to know if there is a possibility for further injury with a ruptured disc at L2 S1??  Is this safe to do without making it worse?  Thank You

A A ruptured disc can get worse in the sense of extending itself into the spinal canal or further to push out against a nerve that controls movement.  When the rupture causes nerve function damage, then a more urgent reassessment needs to be made in regards to a possible surgical decompression.  If one experiences a blockage in the spinal canal with symptoms of paralysis or bowel/bladder loss of control, then this scenario is more of an emergency and needs medical evaluation for possible immediate surgical decompression.  Hope this helps.  If you have further questions, please write back.


Posted July 15, 2006

Q  I have developed a big hook.  I have loosed my grip.  Do you think I need to rotate my hips earlier in my swing?  I was driving the ball very long and straight early in the year and suddenly this hooking started.

A Thank you  for your inquiry.  I will defer the specific golf question to a good friend and excellent teacher, Frankie Costa at www.fcfsu@aol.com to help you.  I know my limits and he can quickly analyze your problem. 

 

 

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